Philadelphia's trauma centers say while they haven't experienced such a large-scale event in recent years, frequent training exercises helped them prepare for the surge of patients following Tuesday's Amtrak derailment in the city.
At least seven area hospitals treated victims, some who arrived by ambulance, others transported by buses from the scene.
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Temple University Hospital handled the brunt of the injuries: 54 patients, including 25 initially admitted for further care.
Dr. Herbert Cushing, chief medical officer at Temple, said shortly after hearing word of the crash, the hospital issued the equivalent of an "all hands on deck" announcement to staff.
"People from key departments who were at home came in to help out, including nurses, doctors, laboratory workers, cafeteria workers, security folks. Everybody that works in the hospital -- and makes it work -- responded and came to the hospital," said Cushing.
More than 40 doctors mobilized, and were prepared to treat additional patients, if necessary. The injured were triaged in a crowded but orderly emergency room.
"All of the trauma patients got a resident doctor as soon as they walked in the door, that was assigned to them, and who stayed with them until it was disposition of the patient ... whether that patient went to the operating room, upstairs to the intensive care unit, or the hospital floor, or over to CAT scan," Cushing said. "So that is how we made sure there was someone on every patient."
According to Cushing, many patients sustained arm and leg injuries or broken ribs. He confirmed that James Marshall Gaines III died after suffering a massive chest injury.
"He came in alive, and was resuscitated a couple of times after his heart stopped, but the third time his heart stopped, he was unable to be resuscitated, and he passed away at 12:25 this morning," said Cushing.
Two patients were in critical but stable condition Wednesday afternoon at Penn Presbyterian, while Hahnemann University Hospital, Aria Health and Thomas Jefferson University Hospital also treated injured passengers.
"Philadelphia is, out of any city in this state, they are probably the best prepared by virtue of the volume of trauma patients they get every day," said Juliet Geiger, executive director of the Pennsylvania Trauma Systems Foundation, an accrediting body.
At Einstein Medical Facility, Dr. Mark Kaplan said the timing of the incident meant they had more than enough staff to treat the nearly two dozen patients they cared for after the derailment.
"As a matter of fact, it was happening at the end of a shift," said Kaplan. "People who were at the end of their shift stayed, people that were coming in for their shift at 11 o'clock came in early. So we had a lot of physicians and a lot of nurses."
Hospitals were in regular contact with one another, Kaplan said, but the sheer volume of injuries made clear communication with first responders a challenge.
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Overall, though, he credited regular disaster-training drills for the relatively smooth medical response across the city.